To compare the magnitude of post-arthroplasty leg length discrepancy (LLD) and incidence of clinically significant LLD measured on CT scanogram using a commonly used measurement method (from the acetabular apex to tibial plafond) to an alternative technique avoiding the use of the acetabular prosthesis as a landmark and to assess inter-observer and intra-rater reliability of the new technique. In this retrospective study, post-arthroplasty LLD measurements were conducted in 100 hips by two interpreters on CT scanogram scout views from the acetabular apex to the tibial plafond (AA-TP) and the inter-teardrop line to the tibial plafond (IT-TP). Aggregate means and proportions of clinically relevant LLD (≥ 10mm) were compared between methods. Inter-rater reliability was calculated, and both interpreters repeated measurements on ten randomly selected patients to calculate intra-rater reliability. The commonly used AA-TP technique overestimated LLD by 3.7mm compared to the IT-TP technique. The odds of LLD measurement exceeding the clinically significant threshold of 10mm were 3.8 times higher when using the AA-TP technique. Excellent inter-rater (ICC 0.984, 0.958) and intra-rater reliability (ICC > 0.9) were found for both techniques. CT scanogram measurements from the acetabular apex to the tibial plafond often overestimate operative limb length due to reference landmarks in different axial planes. Measurements from the inter-teardrop line to the tibial plafond yield significantly lower LLD values, possibly reflecting actual limb length better. The authors recommend using the inter-teardrop line and tibial plafond as reference landmarks to improve LLD assessment accuracy post-arthroplasty.

To investigate return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR), differences based on sex and concomitant meniscal repair, and identify reasons why patients do not RTS. Overall, 232 patients undergoing ACLR, with or without concomitant meniscal repair, that were actively participating in pivoting sports at the time of injury, were prospectively recruited. At 2 years, return to preinjury pivoting sport was investigated and, if they had returned, whether they felt their performance was at (or better) or below preinjury status. Specific reasons for not returning were identified. RTS rates and reasons for not returning were compared based on sex and meniscal repair. Overall, 140 patients (60.3%) had returned to their preinjury pivoting sport, of which 98 (70.0%) felt they were performing at (or beyond) preinjury status. While a significantly greater (p = 0.024) percentage of males (66.9%) versus females (52.4%) had returned to pivoting sports by 2 years, no differences (p = 0.708) were seen based on concomitant meniscal repair. Overall, 92 patients (39.7%) had not RTS, with primary reasons being loss of interest (21.7%), too busy due to their work and/or family environment (22.8%), or fear of reinjury or lacking confidence (17.4%). Other less-reported reasons included ongoing knee issues (6.5%) or not feeling physically ready (5.4%). This study outlined specific reasons why community-level patients do not RTS, with RTS status (and reasons for not returning to preinjury pivoting sports) differing between males and females, with the latter returning at a significantly lower rate overall. Level IV.

To investigate kneeling tolerance in patients undergoing hamstring (HT) versus quadriceps (QT) anterior cruciate ligament reconstruction (ACLR) and investigate correlation with patient-reported outcome measures (PROMs). After recruitment and randomisation, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed at 6, 12 and 24 months using the Kneeling Tolerance Test, which evaluates patient-reported pain in a position of both 90 (KT90) and 110 (KT110) degrees of knee flexion. PROMs collected included the International Knee Documentation Committee (IKDC) questionnaire and the ACL Return to Sport after Injury (ACL-RSI) questionnaire. Kneeling tolerance at KT90 and KT110 improved (p < 0.05) for both graft types across all time points. There was no difference in KT90 scores between groups at 6 or 12 months. At 24 months, kneeling tolerance was superior in the QT group (mean HT 93 ± 9 vs. QT 98 ± 5; p = 0.003). For KT110 scores, a statistically significant difference was noted at 6 (mean HT 80 ± 25 vs. QT 89 ± 12; p = 0.027), 12 (mean HT 90 ± 13 vs. QT 95 ± 10; p = 0.040) and 24 months (mean HT 92 ± 10 vs. QT 97 ± 5; p = 0.003). The ACL-RSI was significantly correlated with KT90 and KT110 at 24 months (r = 0.40, p < 0.001; r = 0.40, p < 0.001). Other PROMs demonstrated significant weak-to-moderate correlations with kneeling tolerance. Patients undergoing ACLR with a QT versus HT autograft report superior kneeling tolerance up to 2 years postsurgery, more prominent in deeper (110°) knee flexion. A strong correlation with ACL-RSI was demonstrated at 2 years. ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry). Level 1.

Background: A growing body of evidence surrounds secondary meniscal and cartilage pathology after delay to anterior cruciate ligament (ACL) reconstruction (ACLR). Many of these studies focus on or include an adult population. Purpose: To elucidate the prevalence of secondary meniscal and chondral pathology with delay to ACLR in the adolescent population as well as examine the influence of sex, skeletal maturity, and trends over the years. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective database was used to identify all patients younger than 19 years who underwent ACLR at the authors’ center between January 1993 and April 2023. Operative data including meniscal and chondral injury and treatment were prospectively recorded at the time of ACLR. A retrospective analysis was performed assessing the relationship between meniscal treatment and chondral injury at ACLR and the time from injury to ACLR, controlling for age, sex, and decade of surgery with multiple regression analysis. Prevalence of meniscal and chondral surgery at ACLR was examined over time and compared between sexes and age groups. Results: A total of 2740 patients were identified with a median age of 17 years (range, 7-19 years). Surgical delay of 5 to 12 months increased the risk of medial meniscal tear requiring surgery by 1.6 (95% CI, 1.1-2.2; P = .007). Surgical delay >12 months increased the risk of medial meniscal tear requiring surgery by 4.2 (95% CI, 3.1-5.8; P = .001) and medial chondral injury by 3.4 (95% CI, 2.2-5.1; P = .001). The repairability of medial meniscal tears decreased with greater delay to reconstruction (57% before 5 months vs 19% after 12 months; P = .001). Lateral meniscal tear repairability followed a similar trend. More male than female participants had secondary pathology (46% vs 39%; P = .001). Patients aged 14-19 years had more meniscal surgery and chondral pathology compared with those younger than 14 years (45% vs 30%, P = .001). Conclusion: Surgical delay >4 months from injury is associated with a steady increase in the prevalence of medial meniscal and chondral pathology in adolescents with ACL rupture. If ACL surgery is delayed >12 months, the odds of requiring medial meniscal surgery is increased by a factor of 4 and the odds of having a chondral lesion is increased by a factor of 3. Timely diagnosis of ACL injury and early surgical referral are important for reducing the odds of meniscal and chondral pathology in adolescents.

Trochleoplasty has shown promising results in selected patients with patellar instability. However, concerns persist regarding its potential relationship with long-term osteoarthritis (OA) and the underlying causes. To evaluate the correlation between postoperative patellofemoral incongruence after trochleoplasty and long-term OA. Cohort study; Level of evidence, 3. The authors conducted a retrospective review of patients who underwent sulcus-deepening trochleoplasty between 2003 and 2013 and identified 43 patients after their initial search. All patients were assessed at a minimum follow-up of 10 years. Preoperative, immediate postoperative, and end-of-follow-up lateral and axial view knee radiographs were used to evaluate patellofemoral OA using the Iwano classification, the patellar articular surface angle (PA), and the trochlear articular surface angle (TA). Data on patellar redislocation, reoperations, and International Knee Documentation Committee (IKDC), Kujala, and patient satisfaction scores were also collected. Pearson correlation analysis was used to evaluate the relationship between articular surface angles and OA, and Spearman rank correlation analysis was used to assess the association between categorical and ordinal variables. A 2-tailed Student t test was used to compare the mean values of the clinical scores between groups. Ten patients (10 knees) met the inclusion criteria, with a mean follow-up of 15.3 ± 3.93 years. The PA and TA were 148.5°± 24.75° and 148.5°± 17.85°, respectively, with a mean patellofemoral incongruence of 21.4°± 16.03°. None of the patients had preoperative OA, and 4 (40%) developed postoperative OA: 2 with Iwano grade 1 and 2 with Iwano grade 2. Higher patellofemoral incongruence was found to correlate with the development of patellofemoral OA (P = .017). No independent correlation was found between the TA and OA (P = .553) or the PA and OA (P = .884). The satisfaction, Kujala, and IKDC scores were 8.2 ± 1.75, 82.5 ± 10.09, and 84.4 ± 9.79, respectively. Only 1 patient (10%) reported a traumatic patellar dislocation, none required reoperations, and all (100%) indicated they would undergo surgery again. This study demonstrated that patellofemoral incongruence after trochleoplasty was associated with the development of long-term OA without an independent correlation with a flat trochlea or a flat patella.

To examine the relationship between menstrual cycle (MC) phase-dependent fluctuations of estrogen and progesterone and virtual cycling race performance, with a secondary aim of correlating perceived MC-related symptoms with performance. In a novel observational study design, 37 female cyclists/triathletes not using any hormonal contraception completed one virtual cycling race (19.5-km time trial (TT)) per week across a 1-month period (totaling four races). Participants completed MC characterization and tracking, including urinary ovulation kits, across two complete MCs. Venous blood samples were collected within 21 h of racing to determine serum 17-β-estradiol and progesterone concentrations, as well as an assessment of self-reported, perceived race-day MC and gastrointestinal (GI) symptoms, which were all then correlated to race performance. There was no relationship between race completion time and individual estradiol ( r = -0.001, P = 0.992) or progesterone ( r = -0.023, P = 0.833) concentrations. There was no difference between race time between MC phases (follicular/luteal, P = 0.238), whether MC bleeding or not bleeding ( P = 0.619), and whether ovulating or not ovulating ( P = 0.423). The total number of perceived MC symptoms recorded on race day was positively correlated to increased race time ( r = 0.268 (95% confidence interval, 0.056-0.457), P = 0.014), as was the number of GI symptoms of at least "moderate" severity before the race ( r = 0.233 (95% confidence interval, 0.021-0.425), P = 0.031), but not post-race ( r = 0.022, P = 0.841). When implementing a novel, virtual cycling race, fluctuations in ovarian hormone concentrations across the MC do not appear to affect real-world cycling performance among trained cyclists, whereas perceived negative MC and GI symptoms may relate to impaired performance. Therefore, the management of negative MC and GI symptoms appears important for athletic performance enhancement or to mitigate performance decline.

Assess the survival of the closing wedge high tibial osteotomy (CWHTO) with failure defined as progression to total knee arthroplasty (TKA) and perioperative complications. Patients undergoing CWHTO in a single centre were included in this study. The patient's demographics, operative data and patient-reported outcome measures were collected from the medical records. The outcomes assessed were progression to TKA, complications and patient-reported outcome measures. The Australian joint registry was used to assess which patients progressed to TKA. A binary logistics regression is used to determine if any of the collected factors increase the likelihood of conversion to arthroplasty. Survival analysis is conducted using a Kaplan-Meier survivorship analysis with failure defined as progression to TKA. Three hundred and fifty-four (244 males and 110 females) patients were included in the study. The average age of the group was 51 years with an average follow-up of 18 years. Patients under the age of 55 had a lower rate of progression to TKA. At 15 years, the rate of progression to TKA was 64% and 85% for those under the age of 55 and over 55, respectively. The complication rate was 6% without any peroneal nerve palsies. CWHTO is a good surgical option particularly when indicated in patients under the age of 55. Additionally, this technique results in a low overall complication rate with an absence of the often-feared complication of peroneal nerve palsy. Level III, Retrospective study.